Predictors and Implications of Early Clinical Stability in Patients Hospitalized for Moderately Severe Community-Acquired Pneumonia.

Assessment of early response to treatment is crucial for the management of community-acquired pneumonia (CAP). To describe the predictors and the outcomes of early clinical stability. We did a secondary analysis of a multicentre randomized controlled trial on CAP treatment in which 580 patients hospitalized for moderately severe CAP were included. The association between demographic, clinical and biological variables available at inclusion and early clinical stability (stabilization of vital signs within 72 hours with predetermined cut-offs) was assessed by multivariate logistic regression. The association between early clinical stability and mortality, severe adverse events, and length of stay was also tested. Younger age (OR 0.98, 95% CI 0.96-0.99), lower platelet count (OR per 10 G/L increment 0.96, 95% CI 0.94-0.98), lower respiratory rate (OR 0.94, 95% CI 0.90-0.97), absence of hypoxemia (OR 0.58, 95% CI 0.40-0.85), lower numbers of co-morbid conditions (OR 0.82, 95% CI 0.69-0.98) and signs or symptoms (OR 0.78, 95% CI 0.68-0.90) were significantly associated with early clinical stability. Patients with early clinical stability had lower 90-days mortality (3.4% vs. 11.9%, p<0.001), fewer admissions to the intensive care unit (2.7% vs. 8.0%, p = 0.005) and a shorter length of stay (6.0 days, IQR 4.0-10.0 vs. 10.0 days, IQR 7.0-15.0, p<0.001). Patients with younger age, less co-morbidity, fewer signs or symptoms, less respiratory compromise, and a lower platelet count are more likely to reach early clinical stability. Patients without early clinical stability have a worse prognosis and warrant close scrutiny

Efecto del bioplaguicida Bacillus thuringiensis (Berliner, 1911), cepa 344, en organismos indicadores del compartimiento acuático.

Resumen: El Bacillus thuringiensis (Berliner, 1911) (Bt) es una bacteria que contiene endotoxinas con acción insecticida para varias especies. A pesar de la conocida inocuidad de la utilización de Bt y otros bioplaguicidas utilizados en la lucha contra las plagas, ha habido algunos informes acerca de las infecciones y los efectos adversos sobre los organismos no blanco, entre estos, especies acuáticas. En este estudio, se evaluó los efectos derivados de la exposición a la cepa 344 del Bt (Bt344) en algunos organismos de diferentes niveles tróficos de la cadena alimentaria acuática. Los organismos de prueba estuvieron expuestos a concentraciones correspondientes a más de 1.000 veces la tasa de aplicación efectiva para controlar el gusano cogollero del maíz (Spodoptera frugiperda). El Bt344 no alteró los patrones de crecimiento de las algas Pseudokirchneriella subcapitata. Una tasa de mortalidad significativa equivalente a 8,9%, pero menor que el límite aceptable para el control (10%), se registró para el pez Hyphessobrycon scholzei. Sin embargo, la exposición al agente biológico disminuyó la supervivencia de Daphnia similis en 44,8%, en comparación con el control. Esto sugiere un riesgo para algunas especies acuáticas de invertebrados

Aceptabilidad del diagnóstico rápido para HIV entre hombres gay y otros hombres que tienen sexo con hombres (G&HSH) de la Ciudad de Buenos Aires

El uso del diagnóstico rápido para HIV en Argentina, así como otros países de Latinoamérica, ha sido limitado hasta el momento. Este trabajo reporta los resultados provenientes de un estudio cualitativo realizado entre hombres gays y otros hombres que tienen sexo con hombres (G&HSH) de la Ciudad de Buenos Aires, Argentina. El objetivo principal del mismo fue conocer las ventajas y desventajas que los hombres G&HSH perciben en relación al diagnóstico rápido casero para HIV. Se realizaron ocho grupos focales con 73 participantes en los cuales se discutió acerca de las ventajas y desventajas del uso de los diagnósticos rápidos. Las respuestas fueron codificadas utilizando un programa para análisis de datos cualitativos (NVivo) y analizadas temáticamente. Los participantes describieron numerosas ventajas sobre el uso del diagnóstico rápido casero, aunque algunos reportaron importantes preocupaciones dentro de las cuales se destaca la posibilidad de impulsos suicidas si alguien recibe un resultado positivo estando solo. En términos generales se observó una gran aceptabilidad para el uso del diagnóstico rápido si el mismo es realizado por personal de salud en lugares acondicionados para este fin.Fil: Balan, Ivan C.. Columbia University; Estados UnidosFil: Carballo Dieguez, Alex. Columbia University; Estados UnidosFil: Marone, Rubén O.. Nexo Asociación Civil; ArgentinaFil: Pando, Maria de Los Angeles. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Microbiología. Centro Nacional de Referencia del Sida; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Barreda, Victoria. Gobierno de la Ciudad de Buenos Aires. Ministerio de Salud; ArgentinaFil: Avila, Maria Mercedes. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Microbiología. Centro Nacional de Referencia del Sida; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentin

β-Lactam Monotherapy vs β-Lactam-Macrolide Combination Treatment in Moderately Severe Community-Acquired Pneumonia: A Randomized Noninferiority Trial.

IMPORTANCE: The clinical benefit of adding a macrolide to a β-lactam for empirical treatment of moderately severe community-acquired pneumonia remains controversial. OBJECTIVE: To test noninferiority of a β-lactam alone compared with a β-lactam and macrolide combination in moderately severe community-acquired pneumonia. DESIGN, SETTING, AND PARTICIPANTS: Open-label, multicenter, noninferiority, randomized trial conducted from January 13, 2009, through January 31, 2013, in 580 immunocompetent adult patients hospitalized in 6 acute care hospitals in Switzerland for moderately severe community-acquired pneumonia. Follow-up extended to 90 days. Outcome assessors were masked to treatment allocation. INTERVENTIONS: Patients were treated with a β-lactam and a macrolide (combination arm) or with a β-lactam alone (monotherapy arm). Legionella pneumophila infection was systematically searched and treated by addition of a macrolide to the monotherapy arm. MAIN OUTCOMES AND MEASURES: Proportion of patients not reaching clinical stability (heart rate <100/min, systolic blood pressure >90 mm Hg, temperature <38.0°C, respiratory rate <24/min, and oxygen saturation >90% on room air) at day 7. RESULTS: After 7 days of treatment, 120 of 291 patients (41.2%) in the monotherapy arm vs 97 of 289 (33.6%) in the combination arm had not reached clinical stability (7.6% difference, P = .07). The upper limit of the 1-sided 90% CI was 13.0%, exceeding the predefined noninferiority boundary of 8%. Patients infected with atypical pathogens (hazard ratio [HR], 0.33; 95% CI, 0.13-0.85) or with Pneumonia Severity Index (PSI) category IV pneumonia (HR, 0.81; 95% CI, 0.59-1.10) were less likely to reach clinical stability with monotherapy, whereas patients not infected with atypical pathogens (HR, 0.99; 95% CI, 0.80-1.22) or with PSI category I to III pneumonia (HR, 1.06; 95% CI, 0.82-1.36) had equivalent outcomes in the 2 arms. There were more 30-day readmissions in the monotherapy arm (7.9% vs 3.1%, P = .01). Mortality, intensive care unit admission, complications, length of stay, and recurrence of pneumonia within 90 days did not differ between the 2 arms. CONCLUSIONS AND RELEVANCE: We did not find noninferiority of β-lactam monotherapy in patients hospitalized for moderately severe community-acquired pneumonia. Patients infected with atypical pathogens or with PSI category IV pneumonia had delayed clinical stability with monotherapy. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00818610

A Catalogue of Optically Selected Cores

We present a new catalogue of 406 dense cores optically selected by using the STScI Digitized Sky Survey (DSS). In this catalogue 306 cores have neither an Embedded YSO (EYSO) nor a Pre-Main-Sequence (PMS) star, 94 cores have EYSOs (1 core has both an EYSO and a PMS star), and 6 cores have PMS star only. Our sample of dense cores in the catalogue is fairly complete within a category of northern Lynds class 5, 6 clouds, and southern Hartley et al. (1986)'s class A clouds, providing a database useful for the systematic study of dense cores. Most of the cores listed in the catalogue have diameters between $0.05 - 0.36$ pc with a mean of $\sim 0.24$ pc. The sizes ($\sim 0.33$ pc in the mean) of cores with EYSOs are found to be usually larger than the sizes ($\sim 0.22$ pc in the mean) of starless cores. The typical mean gas density of the cores is $\sim7\times 10^3 cm^{-3}$. Most of the cores are more likely elongated than spherical (mean aspect ratio: $\sim 2.4$). The ratio of the number of cores with EYSOs to the number of starless cores for our sample is about 0.3, suggesting that the typical lifetime of starless cores is $0.3-1.6$ Myr, about 3 times longer than the duration of the Class 0 and Class I phases. This lifetime is shorter than expected from models of ambipolar diffusion, by factors of 2-44.Comment: 22 pages, 8 figures, 3 tables, and to appear in ApJS. Harvard-Smithsonian Center for Astrophysic

A Medium Survey of the Hard X-Ray Sky with ASCA. II.: The Source's Broad Band X-Ray Spectral Properties

A complete sample of 60 serendipitous hard X-ray sources with flux in the range $\sim 1 \times 10^{-13}$ \ecs to $\sim 4 \times 10^{-12}$ \ecs (2 - 10 keV), detected in 87 ASCA GIS2 images, was recently presented in literature. Using this sample it was possible to extend the description of the 2-10 keV LogN(>S)-LogS down to a flux limit of $\sim 6\times 10^{-14}$ \ecs (the faintest detectable flux), resolving about a quarter of the Cosmic X-ray Background. In this paper we have combined the ASCA GIS2 and GIS3 data of these sources to investigate their X-ray spectral properties using the "hardness" ratios and the "stacked" spectra method. Because of the sample statistical representativeness, the results presented here, that refer to the faintest hard X-ray sources that can be studied with the current instrumentation, are relevant to the understanding of the CXB and of the AGN unification scheme.Comment: 28 pages plus 6 figures, LaTex manuscript, Accepted for publication in the Astrophysical Journal, Figure 5 can retrieved via anonymous ftp at ftp://ftp.brera.mi.astro.it/pub/ASCA/paper2/fig5.ps.g

Phase operators, temporally stable phase states, mutually unbiased bases and exactly solvable quantum systems

We introduce a one-parameter generalized oscillator algebra A(k) (that covers the case of the harmonic oscillator algebra) and discuss its finite- and infinite-dimensional representations according to the sign of the parameter k. We define an (Hamiltonian) operator associated with A(k) and examine the degeneracies of its spectrum. For the finite (when k < 0) and the infinite (when k > 0 or = 0) representations of A(k), we construct the associated phase operators and build temporally stable phase states as eigenstates of the phase operators. To overcome the difficulties related to the phase operator in the infinite-dimensional case and to avoid the degeneracy problem for the finite-dimensional case, we introduce a truncation procedure which generalizes the one used by Pegg and Barnett for the harmonic oscillator. This yields a truncated generalized oscillator algebra A(k,s), where s denotes the truncation order. We construct two types of temporally stable states for A(k,s) (as eigenstates of a phase operator and as eigenstates of a polynomial in the generators of A(k,s)). Two applications are considered in this article. The first concerns physical realizations of A(k) and A(k,s) in the context of one-dimensional quantum systems with finite (Morse system) or infinite (Poeschl-Teller system) discrete spectra. The second deals with mutually unbiased bases used in quantum information.Comment: Accepted for publication in Journal of Physics A: Mathematical and Theoretical as a pape

Avaliação de risco do biopesticida Bacillus thuringiensis (CEPA 344) em organismos bioindicadores presentes em sistemas de produção aqüícola.

A piscicultura e outras atividades aqüícolas vêm ganhando importância por contribuir para a produção de alimentos diferenciados e como uma nova alternativa de renda nas propriedades rurais. O uso de agroquímicos nas regiões de entorno dos sistemas de produção aqüícola constitui uma ameaça para os organismos presentes nos mesmos e para a saúde do consumidor. Assim, tem-se incentivado o uso de produtos de menor risco a base de agentes biológicos de controle utilizados como biopesticidas. Apesar da conhecida inocuidade do uso de biopesticidas usados no combate a pragas, alguns relatos tem ocorrido sobre infecções e efeitos adversos em organismos não-alvo, entre estes, espécies aquáticas. No presente trabalho foi avaliado o efeito decorrente da exposição à cepa 344 de Bacillus thuringiensis (Bt344), em organismos de diferentes níveis tróficos da cadeia alimentar do compartimento aquático. Os organismos-teste foram expostos a concentrações correspondentes a mais de 1.000 vezes a dose de aplicação. O Bt344 não alterou os padrões de crescimento da alga Pseudokirchneriella subcapitata. Uma mortalidade significativa (8,9%), porém inferior ao limite aceitável para o controle (10%), foi constatada para o peixe Hyphessobrycon scholzei. Entretanto, a exposição ao agente biológico reduziu a sobrevivência de Dapnhia similis em 44,8% em relação ao controle, o que sugere um risco para espécies de invertebrados aquáticos

Joint profiling of DNA methylation and chromatin architecture in single cells.

We report a molecular assay, Methyl-HiC, that can simultaneously capture the chromosome conformation and DNA methylome in a cell. Methyl-HiC reveals coordinated DNA methylation status between distal genomic segments that are in spatial proximity in the nucleus, and delineates heterogeneity of both the chromatin architecture and DNA methylome in a mixed population. It enables simultaneous characterization of cell-type-specific chromatin organization and epigenome in complex tissues